Rubella

Key facts

Rubella is a contagious, generally mild viral infection that occurs most often in children and young adults.

Rubella is the leading vaccine-preventable cause of birth defects. Rubella infection in pregnant women may cause fetal death or congenital defects known as congenital rubella syndrome.

There is no specific treatment for rubella but the disease is preventable by vaccination.

Rubella is an acute, contagious viral infection. While rubella virus infection usually causes a mild fever and rash illness in children and adults, infection during pregnancy, especially during the first trimester, can result in miscarriage, fetal death, stillbirth, or infants with congenital malformations, known as congenital rubella syndrome (CRS).

The rubella virus is transmitted by airborne droplets when infected people sneeze or cough. Humans are the only known host.

Symptoms

In children, the disease is usually mild, with symptoms including a rash, low fever (<39°C), nausea and mild conjunctivitis. The rash, which occurs in 50–80% of cases, usually starts on the face and neck before progressing down the body, and lasts 1–3 days. Swollen lymph glands behind the ears and in the neck are the most characteristic clinical feature. Infected adults, more commonly women, may develop arthritis and painful joints that usually last from 3–10 days.

Once a person is infected, the virus spreads throughout the body in about 5-7 days. Symptoms usually appear 2 to 3 weeks after exposure. The most infectious period is usually 1–5 days after the appearance of the rash.

When a woman is infected with the rubella virus early in pregnancy, she has a 90% chance of passing the virus on to her fetus. This can cause miscarriage, stillbirth or severe birth defects known as CRS. Infants with CRS may excrete the virus for a year or more.

Congenital rubella syndrome

Children with CRS can suffer hearing impairments, eye and heart defects and other lifelong disabilities, including autism, diabetes mellitus and thyroid dysfunction – many of which require costly therapy, surgeries and other expensive care.

The highest risk of CRS is in countries where women of childbearing age do not have immunity to the disease (either through vaccination or from having had rubella). Before the introduction of the vaccine, up to 4 babies in every 1000 live births were born with CRS.

Vaccination

The rubella vaccine is a live attenuated strain, and a single dose gives more than 95% long-lasting immunity, which is similar to that induced by natural infection.

Rubella vaccines are available either in monovalent formulation (vaccine directed at only one pathogen) or more commonly in combinations with other vaccines such as with vaccines against measles (MR), measles and mumps (MMR), or measles, mumps and varicella (MMRV).

Adverse reactions following vaccination are generally mild. They may include pain and redness at the injection site, low-grade fever, rash and muscle aches. Mass immunization campaigns in the Region of the Americas involving more than 250 million adolescents and adults did not identify any serious adverse reactions associated with the vaccine.

WHO response

WHO recommends that all countries that have not yet introduced rubella vaccine should consider doing so using existing, well-established measles immunization programmes. To-date, three WHO regions have established goals to eliminate this preventable cause of birth defects. In 2015, the WHO Region of the Americas became the first in the world to be declared free of endemic transmission of rubella.

The number of countries using rubella vaccines in their national programme continues to steadily increase. As of December 2016, 152 out of 194 countries had introduced rubella vaccines, however national coverage varies from 13% to 99%. Reported rubella cases declined 97%, from 670 894 cases in 102 countries in 2000 to 22 361 cases in 165 countries in 2016. CRS rates are highest in the WHO African and South-East Asian regions where vaccine coverage is lowest.

In April 2012, the Measles Initiative – now known as the Measles & Rubella Initiative – launched a Global Measles and Rubella Strategic Plan which covers the period 2012-2020. The Plan includes global goals for 2015 and 2020.

By the end of 2015

By the end of 2020

Achieve measles and rubella elimination in at least 5 WHO regions.

Based on the 2017 Global Vaccine Action Plan (GVAP) Assessment Report by the WHO Strategic Advisory Group of Experts (SAGE) on Immunization, rubella control is lagging, with 42 countries that still have not yet introduced the vaccine and two regions (African and Eastern Mediterranean) that have not yet set rubella elimination or control targets.

SAGE recommends the acceleration of the incorporation of rubella vaccination into the immunization programme , to ensure additional gains in controlling rubella can be made. As one of the founding members of the Measles & Rubella Initiative, WHO provides technical support to governments and communities to improve routine immunization programmes and hold targeted vaccination campaigns. In addition, the WHO Global Measles and Rubella Laboratory Network supports the diagnosis of rubella and CRS cases and tracking of the spread of rubella viruses.